Standards in Immunization Information Systems: Why we need ...
Transcript of Standards in Immunization Information Systems: Why we need ...
Warren Williams, MPH
Informatics Team Lead
European Conference on Immunization Information Systems
December 7-8, 2010
Standards in Immunization Information Systems: Why we need them
How we create them
Immunization Information Systems Support Branch
National Center for Immunization and Respiratory Diseases
Objectives
Understand why US Immunization Information
Systems efforts rely on Standards
Understand some of the process and
timeframes used to create standards
Understand the technical assistance and
evaluation efforts
Illustrate some future directions
Background on US network Of IIS
State based network
Different platforms and
technologies-not one
system
Vendor community
Minimal level of
aggregate data is
reporting to CDC
Types of Standards Used in IIS
Functional Standards
“What are the core function that IIS should be able to do”
Operational Standards
“How IIS functioning to operate in certain areas”
Data Exchange Standards
“How information is structured and organized when it is
exchanged
IIS Functions Standards and Core Data Element
1997 Original Core functional Standards were
established.
2007 Revision these include: Electronically store data on Core Data Elements* Establish Record with 6 weeks of birth Enable access to and retrieval of immunization at time of encounter Protect confidentiality of the information Receive and process information within 1 month of vaccine
administration Ensure security of information Exchange date with HL7 standards Support automatic vaccination forecasting as determined ACIP Support Reminder Recall functions Produce coverage reports Produce official immunization records Promote accuracy and completeness s of registry data
IIS Functions Standards and Core Data Element (continued)
Required set: Patient name: first, middle, last
Patient birth date
Patient sex
Patient race
Patient ethnicity
Patient birth order
Patient birth State/country
Mother’s name: first, middle, last, maiden
Vaccine Type and manufacturer
Vaccine Date and Lot number
Options Set can be found on line :http://www.cdc.gov/vaccines/programs/iis/stds/coredata.htm#whatis
Operational Standards
US IIS have evolved over the years
Many have individually developed great
practices and procedures
Different business rules for different procedures
that cause different data validations/changes
Different edits applied for data quality
MIROW
The Modeling of Immunization Registry Operations
Workgroup (MIROW) of the American Immunization
Registry Association (AIRA) develops Best Practices
for IIS Operational functionality.
MIROW Goals Promote operational consistency
Foster communication and collaboration
Increase credibility of IIS
MIROW Approach Facilitated collaboration of contributing IIS experts to evaluate
and combine various operational practices and achieve a
consensus regarding best practices.
Use of business analysis and modeling techniques to support
development of best practices .
Why is consistency of IIS operations important?
Inconsistency among IIS negatively affects
overall data quality and usefulness of registry
information.
MIROW guidelines are intended to support
uniform alignment of IIS operations.
How MIROW works
MIROW efforts are guided by the Steering Committee
Operational topics for analysis are selected based on feedback from IIS community (assessments, surveys, ad-hoc meetings at NIC)
Panel of experts is assembled for each topic
A combination of face-to-face analysis sessions and web-based teleconferences
External reviews of developed guidelines
Assessments and surveys on implementation in IIS
About 1 topic per year
MIROW participants
Subject matter experts
Steering Committee
Facilitation Teams
AIRA staff
State IIS
External Reviewers
Technical Editors at CDC
What do the MIROW recommendations offer?
Peer-reviewed practical guidelines
Experts from 24 IIS participated in MIROW sessions since
2005, as well as many IIS partners and stakeholders from
public health programs, federal agencies, regional and
county health departments, IT vendors, consultancies, and
private registries.
Guidelines include:
1. A set of agreed upon terms and definitions
2. General principles, specific business rules and
recommendations to apply
3. Illustrative examples and templates
4. Strategies on how to address problems, issues, and barriers
Guideline
document
released
Face-to-face
meeting
Experts’
panel
size
Guideline document
highlights
Reminder/Recall in IIS April
2009
October 2008
2.5 days
Tampa, FL
13 29 Principles
23 Business rules
30 General
Recommendations
Data Quality Assurance in
IIS: Incoming Data
February
2008
August 2007
2.5 days
Atlanta, GA
11 13 Principles
32 Business rules
Vaccination
Level Deduplication in IIS
December
2006
May 2006
2.5 days
20 9 Principles,
20 Business rules,
23 Illustrative scenarios
(examples)
Management of
Moved or Gone Elsewhere
(MOGE) Status and other
Patient Designations in IIS
December
2005
August 2005
2.5 days
Atlanta, GA
16 6 Statuses defined on the
Provider level,
5 Statuses on the
Geographic Jurisdiction
level
IIS-VAERS Guide
(pilot project)
April
2005
June 2004
1.5 days
21 10 Functional standards,
8 Business rules,
11 Alternative scenarios
(process)
Topics
Promoting the MIROW guidelines
Presentations, workshops, and organized ad-hoc
meetings at annual national immunization conferences
Brochure-style mini-guides summarizing each of the
guideline documents - to encourage IIS staff to learn
more about the best practices recommendations
Self-assessment tool for the data quality assurance
guidelines - for gap identification between current IIS
practices and the MIROW best practice
recommendations (has been presented at an AIRA
webinar)
Evaluation results summary
Use of MIROW guidelines by IIS according to IISAR data:
- 46% in 2007
- 76% in 2008
Web survey results
- response rate: 41% (30/74)
-18/19 participants familiar with guidelines
found them to be at least somewhat useful
Average satisfaction among MIROW contributors: -
3.56 / 4
Implementations in KS and WA
The Kansas IIS (KSWebIZ) team developed new reports
at both the provider and system levels to enhance
overall data quality measures in accordance with the
MIROW best practice guidelines on data quality.
The Washington IIS reviewed the MIROW data quality
guidelines to compare current data loading and quality
check practices with the best practices guidelines. As a
result, 21 of the 32 MIROW data quality business rules
were adopted and then current IIS business processes,
policies and procedures were revised and improved to
support the adopted business rules.
Where to get MIROW guidelines?
Copies of the MIROW recommendations
documents can be found at the AIRA web site:
http://www.immregistries.org/pubs/mirow.phtml
Data Exchange Standards
Standards use:
Health Level 7 (HL7)
Information can be found at WWW.HL7.org
Why these are so important
Promotes the obvious computer to computer exchange
Uses in a variety of exchange standards (flat files, data
interchange, etc) once content and structure agreed upon
• i.e. Dates and Vaccine type can be send in different ways as
long as representation is agreed upon
Serves as an anchoring point
HL7 History
Health Level 7 (HL7)
ANSI Standard for clinical interoperability
HL7 was founded in 1987 to promote
communication between hospital data systems
Goal was platform independent method of moving
data between different systems
Grammar for messaging was developed
Standardized vocabulary was developed
HL7 is named for the ISO Open Systems
Interconnection Reference Model Application layer
HL7 Is One of the Interoperability Standards
HL7 is part of the effort to connect disparate
information systems
HL7 is focused on communicating health data
The standards are developed using a
consensus based approach
HL7 Immunization Implementation Guide History
Published in 1999 based on HL7 V2.3.1 and
updated several times
Implemented by many IIS and EHR vendors
Model of successful interoperability
Thousands of messages are transmitted daily
New IG published in May 2010, based on HL7
Version 2.5.1
HL7 version 2.5.1 Immunization Guide Scope
Supporting standardized message structure and
vocabulary for
Sending and receiving immunization histories (VXU)
Requesting immunization history for individual (QBP and RSP)
Acknowledging receipt of message/query and reporting
errors (ACK)
ADT is not covered in depth (referred to IHE profiles)
Technical Assistance in Support of Standards
Great partnerships are key!
American Immunization Registry Association
Public Health Informatics Institute
Evaluation and monitoring
Program evaluation tools
Data analysis
• Sentinel site projects
• http://www.cdc.gov/vaccines/programs/iis/activities/se
ntinel-sites.htm
Routine Monitoring
The Future and Lessons Learned
Standards are used and needed in a variety of areas
Functional, operational guidance, data exchange.
Future Standards:
Constantly evolving to changing information
New ones needed for IIS analysis needs
• Which is the best denominator to use?
• Methodologies for coverage estimation adjustments?
Skills and Planning activities needed to support
standards work:
Good facilitation, experts are very helpful
Good logic listening, focus at the system level
Good communication, new technologies as well as old
Need to evolve
New Initiatives in US IIS efforts
Interoperability
Grantee Support
Technical assistance
Clinical Decision Support
Strategies to improve vaccine forecast
Bar Code efforts to improve vaccine identification
Open the door for modern bar codes on vaccine vials
Improving data analysis capabilities in Sentinel Sites
System enhancements
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
Thank You
Immunization Information Systems Support Branch
National Center for Immunizations and Respiratory Diseases
Warren Williams, MPH
Telephone 404 639-8867